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Top100 Diseases

 endocrine and metabolic diseases

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Diabetes mellitus
Diabetes mellitus is a metabolic disorder, which presents as a spectrum of clinical disorders, which vary in severity. It is characterized by chronic hyperglycemia due to relative insulin deficiency. It is common and affects around 40 million people worldwide. It is a large and important topic in medicine because of its numerous complications, which affect almost all parts of the body.

What to learn
  • Have a reasonable overview of normal glucose metabolism.
  • Classification of diabetes mellitus - types 1 and 2.
  • Symptoms, signs and diagnostic criteria.
  • Complications of diabetes: cardiovascular, eyes, kidneys, neuropathy, feet, infections, skin, and joints.
  • Long-term management with diet, oral hypoglycemics, and insulin.
  • Diabetic emergencies: ketoacidosis and hyperosmolar nonketotic coma.
  • Monitoring treatment.

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A common and increasing problem in the West, obesity is defined as a body mass index (BMI) above 29 and is a risk factor for a number of chronic illnesses, including hypertension, ischemic heart disease, and diabetes.

What to learn
  • BMI and classification of obesity.
  • Socioeconomic risk factors for obesity.
  • Long-term problems associated with obesity.
  • Management of obesity: diet, exercise, medication and surgery.

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Protein energy malnutrition
Starvation is a major cause of morbidity and mortality worldwide. Although not common in developed countries, poverty, inappropriate diet, and coexisting medical conditions, such as surgery, sepsis, cancer, anorexia nervosa and malabsorption syndromes, can produce degrees of starvation.

What to learn
  • Pathophysiology of starvation: understand carbohydrate, fat, and protein metabolism in the fed and starved body states.
  • Classification and clinical features of protein-energy malnutrition.
  • Assessing the degree of malnutrition.
  • Treatment: resuscitation, refeeding, and rehabilitation.

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Thyroid dysfunction
The metabolic activity of many tissues is regulated by the thyroid gland; over- and underactivity of the thyroid are the most common of all endocrine problems. Hypothyroidism can be caused by primary thyroid disease or be secondary to hypothalamic or pituitary disease. Hyperthyroidism is nearly always caused by intrinsic thyroid disease and affects 2% to 5% of females at some time, with a female:male ratio of 5:1.

What to learn
  • Causes and clinical features of hypothyroidism.
  • Investigation and treatment of hypothyroidism.
  • Causes and clinical features of hyperthyroidism.
  • Graves' disease and thyroid eye disease.
  • Acute and long-term management of hyperthyroidism.

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Adrenal dysfunction
The adrenal cortex secretes three main groups of steroid hormones: glucocorticoids, mineralocorticoids, and adrenal androgens. These have wide-ranging effects throughout the body, and therefore the clinical features of adrenal dysfunction are complex. Cushing's syndrome is common, but the main cause is iatrogenic through use of steroid therapy. Addison's disease is rare but is a common topic for exam questions.

What to learn
  • Normal function of the adrenal axis - glucocorticoids and mineralocorticoids.
  • Investigation and diagnostic tests in adrenal disease.
  • Causes, clinical features, and management of Cushing's syndromes.
  • Causes, clinical features, and management of Addison's disease.
  • Hyperaldosteronism and Conn's syndrome.
  • Problems associated with corticosteroid therapy.

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Parathyroid dysfunction
Parathyroid hormone (PTH) is a polypeptide secreted by the chief cells of the parathyroid glands. It acts on the bones and kidneys to increase levels of serum calcium and decrease levels of serum phosphate. Primary hyperparathyroidism is the most common of the thyroid disorders and has a prevalence of 1 per 800 in the UK. Over 90% of patients are over 50 years of age, and the female:male ratio is 2:1.

What to learn
  • Understand the basics of normal calcium metabolism and the mechanisms by which PTH acts to regulate calcium and phosphate
  • Causes, clinical features, and management of primary hyperparathyroidism
  • Definitions of secondary and tertiary hyperparathyroidism, and of renal osteodystrophy
  • Hypoparathyroidism and clinical features of hypocalcemia

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Pituitary tumors
Pituitary tumors are the most common cause of pituitary disease. Clinical features are the result of excess hormone secretion, local effects of the tumor, or inadequate hormone production by the remainder of the gland.

What to learn
  • Understand the normal function of the hypothalamus and pituitary.
  • The common tumor types and clinical syndromes that they cause: prolactinoma, acromegaly, Cushing's disease, non-functioning tumors.
  • Diagnostic tests used in pituitary disease.

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